Beatrice Jean Kalisch

Background: An acceptable, reliable, and valid survey instrument to measure missed nursing care in perioperative settings has not been developed.Purpose: To develop and conduct psychometric testing of the MISSCARE Survey OR.Methods: Data were collected nationwide from 1,693 operating room (OR) nurses who completed the MISSCARE Survey OR. The survey contained two sections: Part A, “Elements of perioperative nursing care” (32 questions) and Part B, “Reasons for missing nursing care” (17 questions).Results: The MISSCARE Survey OR demonstrated acceptability, as few respondents missed questions in Part A (0.1%–1.1%) and Part B (0.8%–1.3%). Exploratory factor analysis revealed five subscales in Part A (Legal, Preparation, Safety, Communication, and Closing) and four in Part B (Urgency, Staffing, Materials, and Teamwork). In Part A, the five-factor solution explained 44% of the variance. In Part B, the four-factor solution explained 53% of the variance. Alpha coefficients for subscales in Part A ranged from 0.71 to 0.84 and 0.74 to 0.90 for Part B. Validity was measured using content validity, criterion validity, and construct validity. A panel of OR nurse experts established content validity. Criterion validity compared hospitals with fewer than six ORs to hospitals with hospitals with more than six ORs where it was hypothesized aprior that nurses in hospitals with fewer ORs would have missed less care (X = −.123, standard error [SE] = .041, p = .003). Construct validity was tested through exploratory and confirmatory factor analyses (CFA). Correlation coefficients for Part A ranged from 0.34 to 0.73 and 0.60 to 0.73 for Part B. Overall model fit was acceptable: goodness-of-fit index (GFI) and CFA were greater than 0.90, standardized root mean square residual (SMRM) was less than 0.06, and root mean square error of approximation (RMSEA) less than 0.08.Conclusion: The MISSCARE Survey OR promises to be a reliable, valid indicator of the extent of and reasons for missed nursing care.

The purpose of this study was to test the psychometric properties of the Nursing Teamwork Survey‐Icelandic (NTS‐Icelandic), which was translated from US English to Icelandic. The Nursing Teamwork Survey, with 33 items, measures overall teamwork and five factors of teamwork: trust, team orientation, backup, shared mental models, and team leadership. The psychometric testing of the NTS‐Icelandic was carried out on data from a pilot study and a national study. The sample for a pilot study included 123 nursing staff from five units, and the sample for a national study included 925 nursing staff from 27 inpatient units. The overall test–retest intraclass correlation coefficient in the pilot study was 0.693 (lower bound = 0.498, upper bound = 0.821) (p < 0.001). The Cronbach's alpha reliability for the total scale and subscales ranged from 0.737 to 0.911. A confirmatory factor analysis indicated a good fit of the data from the national study with the five‐factor model for nursing teamwork. The NTS‐Icelandic tested valid and reliable in this study. Study findings support further use of the Nursing Teamwork Survey internationally.

A series of studies on missed nursing care (i.e., required standard nursing care that is not completed) is summarized. Missed nursing care is substantial and similar levels are found across hospitals. Reasons for missed nursing care are staffing resources, material resources, and communication and these are also similar across hospitals. The higher the staffing levels, the fewer occurrences of missed nursing care. Magnet status and higher levels of teamwork are associated with less missed nursing care, and more missed care leads to a lower level of staff satisfaction. Missed nursing care has been found to be a mediator between staffing levels and patient falls. Patient identified missed nursing care predicts adverse events (i.e., falls, pressure ulcers, new infections etc.).

The purpose of this study was to test the use of virtual simulation to improve teamwork among nursing staff. Using a quasi-experimental design, nursing staff ( n = 43) from one patient care unit participated in a 1-hr session, which focused on common nursing teamwork problems. The overall mean teamwork scores improved from pre- ( M = 3.25, SD = 0.58) to post-intervention ( M = 3.49, SD = 0.67, p < .012). The intervention also had large (0.60 ≤ d ≤ 0.97) and significant effects on the measures of three teamwork subscales (i.e., trust, team orientation, and backup).

Background: Teamwork is essential for patient safety and results in less missed nursing care. Objectives: The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care. Methods: This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical–surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons. Results: Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention. Discussion: The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.

The aim of this study was to determine the extent and type of missed nursing care as reported by patients and the association with patient-reported adverse outcomes. A total of 729 inpatients on 20 units in 2 acute care hospitals were surveyed. The MISSCARE Survey–Patient was used to collect patient reports of missed care. Patients reported more missed nursing care in the domain of basic care (2.29 ± 1.06) than in communication (1.69 ± 0.71) and in time to respond (1.52 ± 0.64). The 5 most frequently reported elements of missed nursing care were the following: (a) mouth care (50.3%), (b) ambulation (41.3%), (c) getting out of bed into a chair (38.8%), (d) providing information about tests/procedures (27%), and (e) bathing (26.4%). Patients who reported skin breakdown/pressure ulcers, medication errors, new infections, IVs running dry, IVs infiltrating, and other problems during the current hospitalization reported significantly more overall missed nursing care.

Missed nursing care refers to omission of standard required nursing care of patients in acute care hospitals. The objective of this study was to compare the amounts and reasons of missed nursing care, the level of nurse staffing, and job satisfaction between the United States and Lebanon. Several studies in the United States have shown that a significant amount of care is being missed. This study is designed to determine if Lebanon is experiencing a similar phenomenon and what reasons are given for missing nursing care. Findings support that a substantial amount of nursing care is missed in Lebanon, although less than that in the United States (t = 11.53, P < .001), that nurses in Lebanon were less satisfied with being a nurse than are nurses in the United States, and there was no difference in the identification of staffing resources as a reason for missed care in the 2 countries.

This article examines literature that provides evidence about the safety of mobilizing hospitalized adults. A search of electronic databases and hand searches yielded 24 studies that were included in the review. Evidence of mobilization safety was found in 4 clinical settings (medical, surgical, cardiac procedure, and intensive care), and the findings from these studies suggest that early mobilization of hospitalized adults is safe.